Individual provider Active NPI

Damilola Funmilade Jibowu, MD, MPH

  • Pediatrics Physician
  • Durham, NC
National Provider Identifier
1184112559
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2021-02701 Issued in NC
Practice address
1301 Fayetteville St
Durham, NC 27707-2325
Phone
(919) 956-4000
NPI assigned
May 1, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2021-02701 NC Primary

Addresses

Primary practice location

1301 Fayetteville St
Durham, NC 27707-2325

Mailing address

CB 7593
Chapel Hill, NC 27599-7593
Phone (919) 966-3172

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220817000366 NC Practitioner - Pediatric Medicine 5991051435 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2021-02701NCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln Community Health Center Incorporated CurrentSince Apr 1, 2022 Accepting new patients
Lincoln Community Health Center Incorporated CurrentSince Apr 1, 2022 Accepting new patients

Locations

1301 Fayetteville St
Durham, NC 27707
Phone (919) 956-4000

Interoperability endpoints

  • Direct secure messaging: djibowu501234@direct.medicine.duke.edu

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1184112559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CB 7593",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275997593",
            "telephone_number": "919-966-3172",
            "fax_number": "919-966-8419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 FAYETTEVILLE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072325",
            "telephone_number": "919-956-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIBOWU",
        "first_name": "DAMILOLA",
        "middle_name": "FUNMILADE",
        "name_prefix": "Dr.",
        "credential": "MD, MPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-01",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2021-02701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.